JCCVS
Journal of Cardiology & Cardiovascular Surgery

Journal of Cardiology & Cardiovascular Surgery scientific, open-access, double-blind peer-reviewed journal covering a wide spectrum of topics in cardiology and cardiovascular surgery. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

eISSN: 2980-1397
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Online Manuscript System

Index
Original Article
Hemodynamic effects of etomidate anesthesia induction in diabetic and non-diabetic patients: Importance of heart rate variability in early detection of cardiac autonomic dysfunction
Abstract
Aims: Cardiovascular diseases represent the primary cause of perioperative morbidity among diabetic patients. Etomidate, an anesthetic agent with minimal cardiovascular effects, is commonly used in these patients. Diabetic patients often experience cardiovascular autonomic neuropathy, a severe complication of diabetes. In recent years, measuring heart rate variability has become increasingly important for early detection of cardiac autonomic dysfunction. The aim of this study was to compare the hemodynamic effects of etomidate anesthesia induction between diabetic and non-diabetic patients.
Methods: This was a prospective randomized study that enrolled consecutive ASA I-III patients scheduled for various elective surgeries under general anesthesia. The patients were divided into two groups: Group D (diabetic, n = 21) and Group ND (non-diabetic, n = 21). Heart rate variability analyses were performed using a Norav-800 Holter on the day before surgery. On the day of the operation, after premedication and monitoring, general anesthesia was induced with etomidate. Hemodynamic parameters were measured before induction (T1), after induction (T2), and 2 min (T3), 5 min (T4), and 10 min (T5) after endotracheal intubation. Hemodynamic changes and heart rate variability were compared between the two groups.
Results: Group D showed a statistically significant decrease in systolic arterial pressure values at T2, T4, and T5 compared to baseline values (p < 0.001), while Group ND showed no significant differences in any period. Diastolic blood pressure decreased significantly in Group D compared to baseline values in the preintubation period (p < 0.001), but there was no significant change in Group ND. Heart rate did not significantly differ between the two groups during any measurement period, and there was no correlation between heart rate variability and hemodynamic changes.
Conclusion: The results suggest that etomidate anesthesia induction provides hemodynamic stability in patients with type 2 diabetes mellitus. Despite its potential utility, heart rate variability measured during resting conditions may not provide sufficient diagnostic accuracy for predicting the presence of autonomic neuropathy, particularly in individuals with diabetes mellitus.Therefore, additional measures may be needed for early detection of cardiac autonomic dysfunction in these patients.

Keywords : Autonomic dysfunction, etomidate, diabetes mellitus, heart rate variability

Download Article


1. Connery LE, Coursin DB. Assessment and therapy of selectedendocrine disorders. Anesthesiol Clin North Am. 2004;22(1):93-123.doi:10.1016/s0889-8537(03)00111-1
2. Ziegler D, Gries FA, M&uuml;hlen H, Rathmann W, Sp&uuml;ler M, LessmannF. Prevalence and clinical correlates of cardiovascular autonomic andperipheral diabetic neuropathy in patients attending diabetes centers.The Diacan Multicenter Study Group. Diabete Metab. 1993;19 (1 Pt2):143-151.
3. Maser RE, Mitchell BD, Vinik AI, Freeman R. The association betweencardiovascular autonomic neuropathy and mortality in individualswith diabetes: a meta-analysis. Diabetes Care. 2003;26(6):1895-901.doi:10.2337/diacare.26.6.1895
4. Vinik AI, Erbas T. Recognizing and treating diabetic autonomicneuropathy. Cleve Clin J Med. 2001;68(11):928-30, 932, 934-44. doi:10.3949/ccjm.68.11.928
5. Ebert TJ, Muzi M, Berens R, Goff D, Kampine JP. Sympathetic responsesto induction of anesthesia in humans with propofol or etomidate.Anesthesiology. 1992;76(5):725-33. doi:10.1097/00000542-199205000-00010
6. Heart rate variability: standards of measurement, physiologicalinterpretation and clinical use. Task Force of the European Societyof Cardiology and the North American Society of Pacing andElectrophysiology. Circulation. 1996;93(5):1043-1065.
7. Keyl C, Lemberger P, Palitzsch K-D, Hochmuth K, Liebold A, HobbhahnJ. Cardiovascular autonomic dysfunction and hemodynamic responseto anesthetic induction in patients with coronary artery disease anddiabetes mellitus. Anesthesia &amp; Analgesia. 1999;88(5):985-991.
8. Wolf MM, Varigos GA, Hunt D, Sloman JG. Sinus arrhythmiain acute myocardial infarction. Med J Aust. 15 1978;2(2):52-53.doi:10.5694/j.1326-5377.1978.tb131339.x
9. Linstedt U, Jaeger H, Petry A. [The neuropathy of the autonomicnervous system. An additional anesthetic risk in diabetes mellitus].Anaesthesist. 1993;42(8):521-527. Die Neuropathie des autonomenNervensystems. Ein zus&auml;tzliches Narkoserisiko beim Diabetes mellitus.
10. Latson TW, Ashmore TH, Reinhart DJ, Klein KW, Giesecke AH.Autonomic reflex dysfunction in patients presenting for electivesurgery is associated with hypotension after anesthesia induction.Anesthesiology. 1994;80(2):326-337. doi:10.1097/00000542-199402000-00013
11. Burgos LG, Ebert TJ, Asiddao C, et al. Increased intraoperativecardiovascular morbidity in diabetics with autonomic neuropathy.Anesthesiology. 1989;70(4):591-597. doi:10.1097/00000542-198904000-00006
12. Vohra A, Kumar S, Charlton AJ, Olukoga AO, Boulton AJ, McLeod D.Effect of diabetes mellitus on the cardiovascular responses to inductionof anaesthesia and tracheal intubation. Br J Anaesth. 1993;71(2):258-261.doi:10.1093/bja/71.2.258
13. Kn&uuml;ttgen D, Weidemann D, Doehn M. Diabetic autonomic neuropathy:abnormal cardiovascular reactions under general anesthesia. KlinWochenschr. 1990;68(23):1168-1172. doi:10.1007/bf01815272
14. Hanss R, Bein B, Weseloh H, et al. Heart rate variability predicts severehypotension after spinal anesthesia. Anesthesiology. 2006;104(3):537-545.doi:10.1097/00000542-200603000-00022
15. Schwarzkopf KR, Hueter L, Simon M, Fritz HG. Midazolam pretreatmentreduces etomidate-induced myoclonic movements. Anaesth IntensiveCare. 2003;31(1):18-20. doi:10.1177/0310057x0303100103
Article available in :
Volume 1, Issue 4, 2023
Page : 61-65
https://doi.org/10.51271/JCCVS-0017
Article Information
Received : 07 Mar 2023
Accepted : 25 Eki 2023
Published : 29 Ara 2023
Corresponding Author :

Alparslan Koç: Department of Anesthesiology and Reanimation, Erzincan Binali Yıldırım University Mengucek Gazi Training and Research Hospital, Erzincan, Turkiye

[email protected]
Citation : Koç A, Uzman S. Hemodynamic effects of etomidate anesthesia induction in diabetic and non-diabetic patients: Importance of heart rate variability in early detection of cardiac autonomic dysfunction. J Cardiol Cardiovasc Surg. 2023;1(4):61-65.

Read: 238
Cited: 0
Download : 226
_Footer